Title: Name:	Address incl Post Code:	Telephone: Day Evening Mobile
Top Eccles Farm Booking Form
Any information that you provide, will be kept in the strictest confidence and will not be given to any third parties
Name and address of the person making the booking
Holiday dates (weeks run from Saturday 3pm - Saturday 10am)
Arrival Date (dd/mm/yy)	Departure Date (dd/mm/yy)
Party Members
Mr,Mrs,Miss,Dr	First Name	Last Name	DOB if under 18




Requirements (please tick and give further details if applicable Twin bedroom and double bedroom: Two double bedrooms: Cot: Playpen: High Chair: Collection from public transport links: Other special requirements:		Additional information:
Where did you find out about the Eco Barn at Top Eccles Farm?
Accommodation		Ł
Welcome Box		Ł
Vegetable Box		Ł
Total Charge		Ł
Deposit (50% of accommodation charge)		Ł

I enclose a non-refundable deposit of 50% of the accommodation charge to confirm my booking. I understand that the remaining 50% plus the charge for the Welcome/Vegetable Box must be settled at least 1 month before the holiday commences.
I enclose a non-refundable payment in full, as the holiday commences in less than 1 month.
Please delete as applicable
I will endeavour to be an environmentally conscious visitor and undertake to leave the property in a clean and tidy condition and be responsible for any damages and breakages howsoever caused.
Signed
Date

Please make cheques payable to Top Eccles Farm and send with this form to:
Andrew and Elizabeth Woodward
Top Eccles Farm
Eccles Road
Whaley Bridge
Derbyshire SK23 7EW.

A receipt and confirmation of your booking will be immediately sent to you. Any questions then please ring Liz or Andrew on 01663 750372 or email ecobarn@topecclesfarm.co.uk